# An Above-Average Lymph Node Yield Removed During Curative Neck Dissection in Advanced Head and Neck Squamous Cell Carcinomas Improves Survival

## TL;DR

Removing more lymph nodes during surgery for advanced head and neck cancer can significantly improve patient survival, especially on the side opposite the tumor.

## Contribution

This study shows that an above-average lymph node yield during neck dissection improves survival in advanced head and neck cancer patients.

## Key findings

- An above-average lymph node yield improved survival in bilateral, ipsilateral, and contralateral neck dissections.
- Contralateral neck dissection with a higher node yield was strongly linked to better overall survival.
- The study spanned 25 years and included 234 patients with advanced HNSCC.

## Abstract

For appropriate treatment, lymph nodes must be removed in advanced squamous cell cancers of the head and neck in a procedure called neck dissection. The surgeon’s aim is to minimise surgical risk while achieving the best possible outcome, so the question of how many lymph nodes should be resected in these cases to gain a long survival remains a topic of discussion. The patient data, surgery information, and outcome of a total of 234 patients with this type of cancer who were treated at a German university hospital between 1997 and 2018 were investigated. The study showed that a thorough neck dissection involving an above-average number of nodes can improve survival rates, especially when performed on the side opposite the primary tumour.

Objectives: The lymph node yield of a curative neck dissection for advanced head and neck squamous cell carcinoma (HNSCC) is an important factor in improving patient outcomes. Achieving adequate resection while minimising surgical risk is important. This retrospective study investigated the role of the lymph node yield for the survival of patients with HNSCC. Methods: A total of 234 patients with advanced HNSCC who were treated at a German university hospital between 1997 and 2018 were analysed. The analysis included patient data, tumour-specific characteristics, and the extent of neck dissection performed. Statistical analysis was performed using multivariate Cox proportional hazards models, supplemented by Kaplan–Meier analyses. Results: The median age was 60.0 years (range: 30–85 years, interquartile range: 12.3 years). The follow-up period covered up to 25 years. According to the Union for International Cancer Control, n = 64 patients had UICC-stage III, and 170 patients had UICC-stage IV. The above-average lymph node yield was superior to average, but especially to below-average lymph node yields in bilateral (2.9-fold), ipsilateral (2.6-fold), and contralateral (10.7-fold) neck dissection. In particular, contralateral neck dissection was found to correlate with a significantly better prognosis in terms of overall survival when a higher number of lymph nodes were removed. Conclusions: The study suggests that a thorough and careful neck dissection involving the removal of a greater number of lymph nodes and including the contralateral side could significantly improve the survival for patients with advanced HNSCC.